Name of Student:
Name of Supervisor:
Agency:
Address:
Phone: Hours Completed: Date:
Directions:
A meaningful performance evaluation must give an accurate
description of the student's performance in carrying out
assignments. Nine field outcomes guide the expected learning
experiences. Please rate the student on the nine
outcomes based on the activities and performance criteria
outlined in the Student Field Practicum Contract.
Please use the following scale to indicate your estimation of
the student's level of current functioning. You may include
fractions (e.g., 3.5) if they provide a more precise indication
of the student's performance. This evaluation accounts for 35%
of the student's overall grade in the course.
4 = Excellent Performance is consistently above what is
expected
3 = Above Performance is above what is generally expected.
Average
2 = Average Performance is at the expected level.
1 = Below Ave. Performance is frequently below expected level.
0 = Poor Unable to perform
NA = Not No opportunity to perform this in practicum.
Applicable
Conclude with a statement summarizing strengths and areas for
attention or further development.
Outcome #1
To utilize knowledge of organization's structures and service
delivery system on behalf of the client population.
STUDENT ACTIVITIES/TASKS
- Continue reading agency policies regarding services
available.
- Visit other units of the agency to observe and gain knowledge
about other services available throughout the agency.
- Become familiar with steps involved in making referrals for
services within the agency.
- Refer clients to appropriate services.
OUTCOME MEASURES: Student will be able:
RATING
To discuss treatment options with clients and staff.
To refer clients to appropriate treatment program
when indicated.
COMMENTS:
Outcome #2
To use theoretical frameworks to explain interactions between
individuals, families, and groups.
STUDENTS ACTIVITIES/TASKS
- Select at least one theoretical framework (from classes/readings)
and discuss with supervisor how it may explain the interactions
between individuals, families, and groups.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate an understanding of how theories may help to
explain interactions between individuals, families, and groups.
COMMENTS:
Outcome #3
To identify and assess situations with families and groups using
generalist practice knowledge.
STUDENT ACTIVITIES/TASKS
- Complete assessment process with clients.
- Write progress notes for individual and family sessions.
- Gain exposure to groups by facilitating a group.
- Interact with and provide support to families as needed.
OUTCOME MEASURES: Student will be able:
RATING
To gather relevant and necessary information to complete
assessments (family/group) based on generalist practice
knowledge.
To write progress notes that accurately reflect client
system needs and progress in treatment.
COMMENTS:
Outcome #4
To develop intervention plans that meet clients' needs
(family & groups) while maintaining the Code of Ethics for
social work practice.
STUDENTS ACTIVITIES/TASKS
- Develop and document plans in progress notes that follow
agency policy for service to clients.
- Become familiar with DSM IV through independent study.
- Assist treatment teams in designing plans that meet client
needs/goals.
- Provide individual and family counseling to clients as
needed.
OUTCOME MEASURES: Student will be able:
RATING
To develop plan based on assessment of needs that
includes specific goals and objectives and to evaluate
progress toward goals.
To conduct effective individual and family sessions that
support client and offer help in meeting goals and
objectives.
COMMENTS:
Outcome #5
To understand published research and apply research findings to
practice.
STUDENTS ACTIVITIES/TASKS
- Read assignments regarding risk population for your setting.
- Apply information gained in research review.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate knowledge of subject matter.
Ability to discuss issues unique to the agency's
population.
To relate the needs and behaviors of the population
served by the agency to their life-span development.
COMMENTS:
Outcome #6
To develop an understanding of how social systems impact groups
most at risk (women, low income, persons of color).
STUDENTS ACTIVITIES/TASKS
- Continue interacting with diverse clients and staff,
especially clients at risk.
- Learn through classroom readings regarding various cultural
groups.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate an understanding of individual diversity
and its impact on family dynamics and treatment issues.
To demonstrate an ability to accept and relate
effectively with staff and clients of diverse
backgrounds.
COMMENTS:
Outcome #7
To use supervision and consultation to enhance learning.
STUDENTS ACTIVITIES/TASKS
- Hold individual supervisory sessions on a regular basis.
- Bring forth concerns, observations, and questions during
these conferences.
- Consult with other knowledgeable persons.
OUTCOME MEASURES: Student will be able:
RATING
To share observation and insights regarding
clients.
To ask questions to enhance learning.
To relate material learned in the classroom
(i.e. theories) to direct work with clients.
To accept and learn from supervisor's feedback.
_____ To accept and learn from at least one consultant
(knowledgeable person).
COMMENTS:
Outcome #8
To write documentation according to the requirements and
guidelines of the agency (mention supervisor's appraisal).
STUDENTS ACTIVITIES/TASKS
- Become familiar with agency procedures regarding various
paperwork and documentation.
- Dictate accurate and well-organized assessments, social
histories, progress notes, and accurately complete
appropriate forms.
OUTCOME MEASURES: Student will be able:
RATING
To document treatment process in a way that shows
continuity from assessment to termination.
To create well-organized and grammatically correct
documents.
COMMENTS:
Outcome #9
To use communication skills differentially across client populations, colleagues, and communities. STUDENTS ACTIVITIES/TASKS - Use language differentially in communicating (orally and/or in writing) with clients, colleagues, and others. (Terminology, approach, and other relevant variables may differ depending on whom you are communicating with).
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate flexibility and skill in adapting communication
to suit the person with whom you are communicating.
COMMENTS:
Overall summary statement of student's strengths and
areas for further development.
Overall Rating Signatures Upon Completion Signatures Upon Completion of Contract of Evaluation
Student Date Student Date
Supervisor Date Supervisor Date
Field Coordinator Date Sample 9/04
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Last Updated August 30, 2004 by Theresa Myadze